Looking at Romneycare: Mitt Romney Gets More Specific on Health Reforms
Throughout his candidacy, Mitt Romney’s mantra was has been that the Affordable Care Act may have been right for Massachusetts, but it’s wrong for the country.
So what is his alternative?
At a campaign stop last week, the presumptive GOP nominee gave a broad glimpse of what his health care agenda would look like should he be elected president. I talked with Michael Gusmano, a research scholar at The Hastings Center, in Garrison, NY, to me translate Romney’s proposals.
1. The uninsured: “I would help take the Medicaid dollars that comes with all sorts of strings attached today, send them back to the states along with something known as the DSH money, and let states care for their own people in the way they think best.”
Gusmano said Romney is talking about block grants. These are “fixed-sum” federal funds that let states choose how they will use the money. Gusmano said the purpose of these grants is to limit the federal government’s obligation. There is a fixed pot, so the government’s match wouldn’t increase if the number of enrollees rise or a state expands its program, for instance.
Block grants may give states freedom, but they can also create geographic inequity, Gusmano said. In a place like Missouri, which is known for cutting Medicaid whenever it can, those funds could be diverted to other programs. Should a poor child in Missouri have a disadvantage over a poor child in a state like New York that has a generous Medicaid program?
2. The individual market: “What I would do is level the playing field and say individuals can buy insurance on the same tax advantage basis that businesses can buy insurance.”
There are two issues to consider, Gusmano said. First is the tax impact of the proposal. No one knows how much less money the government would take in by providing tax breaks to individuals and small businesses, but Gusmano said it would be significantly less. The important question would be whether it would be greater than the tax credits provided by the Affordable Care Act.
Second, individuals who can’t afford private insurance now couldn’t afford it –even with a tax deduction – without insurance reform. “It could really help people who are self-employed, but how much is unclear until we know if insurance regulations will be changed, too,” Gusmano said.
3. Pre-existing conditions: "So, we're going to have to make sure … that people who have a pre-existing condition—who've been insured in the past are able to get insurance in the future—don't have to worry about that condition keeping them from getting the kind of health care they deserve."
This is a dramatic departure from the ACA, which prohibits insurers from turning down someone with a pre-existing condition, regardless of whether or not he or she was previously insured. Gusmano said Romney’s goal is to prevent the kind of scenario where a young adult buys insurance only after being diagnosed with an illness.
The problem with this position is that it assumes that everyone who is uninsured has a choice. Some people cannot afford premiums for the insurance their employer offers. Others may have pre-existing conditions and can’t afford high-risk state plans or COBRA insurance if they are laid off.
4. Insurance reform: “I want these individuals and businesses to be able to buy insurance across state lines to get the best deal they can get anywhere in the country.”
Gusmano said this would allow people a greater choice and the ability to buy cheaper plans if they live in a state, like New Jersey, that has very expensive rates on individual health insurance. But insurers also could move their headquarters to any state they want.
And where would they go? Somehow, I can’t imagine they would all flock to states that have the most stringent insurance regulations.
Photo credit: Gage Skidmore via Flickr